The appearance of red marks beneath the eyes is a common concern. The skin surrounding the eye, known as the periorbital area, is distinctly thin, measuring less than one millimeter in thickness. This delicate structure makes it highly susceptible to inflammation, irritation, and visible changes in color. Understanding the reasons behind this redness, which range from chronic conditions to temporary reactions, can help determine the appropriate course of action.
Chronic Inflammatory Skin Responses
Persistent redness, scaling, or inflammation under the eyes frequently indicates a chronic inflammatory skin condition, such as Atopic Dermatitis (eczema). This condition involves a compromised skin barrier due to an overactive immune response. It makes the area dry, intensely itchy, and often leads to thick, scaly patches. Flares are often triggered by genetics, environmental factors, and allergies, presenting with a dry, dull appearance.
Seborrheic Dermatitis, another form of eczema, targets areas rich in sebaceous glands, including the eyelids. Unlike the dry presentation of Atopic Dermatitis, this condition causes red patches covered with a greasy, yellowish, or white scale. The redness is associated with the presence of the Malassezia yeast, which contributes to the inflammatory response. Management differs: Atopic Dermatitis requires intense moisturization, while Seborrheic Dermatitis often requires antifungal treatments.
Acute External Irritants and Allergic Contact
Red marks under the eyes can result from an acute reaction to a substance contacting the skin barrier, categorized as Contact Dermatitis. Irritant Contact Dermatitis occurs when a substance directly damages the outer skin layer, causing immediate redness, stinging, and burning. Common irritants include harsh soaps, cleansers, dust, or chemicals like chlorine, which strip the skin’s protective oils.
Allergic Contact Dermatitis is a delayed immune system reaction, manifesting 48 to 72 hours after exposure to a specific allergen. Triggers are often found in personal care products, such as preservatives in eye creams, fragrances in cosmetics, or chemicals transferred from nail polish via finger contact. The rash is characterized by redness, intense itchiness, and sometimes blistering, as immune memory cells react to the perceived threat.
Structural and Lifestyle Contributors
In some cases, visible redness relates to the physical structure of the area rather than inflammation or allergy. Because the skin under the eyes is extremely thin, underlying blood vessels and muscle are closer to the surface, making their color more apparent. This vascular visibility can lead to a reddish-blue hue, often exacerbated by factors that increase blood flow or cause fluid retention.
Mechanical irritation is a common lifestyle contributor, where excessive rubbing or wiping causes friction and trauma to the skin. This repeated physical stress triggers a mild inflammatory response, leading to temporary but recurrent redness. Sleep deprivation and fatigue also contribute by causing puffiness (edema) in the lower eyelid area. The swelling stretches the thin skin, increasing the visibility of pooled blood and resulting in a darker, reddish appearance.
When Professional Medical Evaluation is Necessary
While many causes of under-eye redness are manageable with simple avoidance or over-the-counter treatments, certain signs warrant prompt medical attention. Any redness accompanied by a sudden change in vision, blurred or double vision, or severe sensitivity to light should be evaluated immediately by a healthcare professional. These symptoms may indicate a more serious condition affecting the eye itself.
Signs of Infection or Severe Reaction
Infections, such as cellulitis, present with rapidly spreading redness, fever, intense pain, warmth, or significant swelling that makes eye movement difficult. Consultation with a dermatologist or ophthalmologist is advised if the redness persists for longer than a week without improvement. Professional guidance is also necessary if the redness is accompanied by thick discharge, open sores, or blistering.